Therapist: An Ethical Dilemma

Introduction
In this essay I am going to examine the information given from Miss E and plan an ethical approach to working with her and attach a copy of the screed. During the initial consultation the ethical therapist would use counselling skills to explore and identify any deeper issues that the client may wish to address. Using and creating a safe environment for the client the therapist would gather as much information as possible and be prepared to vary the style of questioning and plan for different types of intervention. There may be some issues that are revealed too far removed from the therapist level of expertise and as such should be aware of other options.
The therapist will need to learn the different styles of questioning
and to use the most appropriate during any discussion with the client. Such as:
• Closed questions – the answer factual or yes, no.
• Open questions – these questions can have the effect of encouraging discussion. Generally they cannot be answered by yes or no butseek further clarity.
• Reflective questioning – each question is based on the previous answer and reflects the content of that answer.
• Probing questions – used when pursuing a certain line of enquiry.
• Leading questions – used to influence, not useful in information gathering but can be used as a covert suggestion.
• Multiple questions – not useful in any sense of hypnotherapy, can cause confusion and prevents client from thinking.
• Combinations of questions – putting different types of questions together to lead to a deeper understanding of the issue. (handout 6)
The first 30 minutes of the initial consultation would be free of charge as it gives me an opportunity to assess whether I can treat Miss E ethically and within my expertise as a therapist. Many people have weight issues which are related to some form of emotional problem and are acted through their relationship with food. Eating can become, and is often used as, some form of coping mechanism in order to deal with anxiety and unresolved issues.
In addition to this during the initial interview the therapist would establish:
• what the client 's issues and goals are
• detailed history of food and dieting
• determine motivation 0 -10
• if used hypnotherapy before and if for weight loss and result
• reasons for overeating and if client identifies with any
• gain info of food and relationship when young
• look at the danger areas, triggers for the client
• identify any hidden agendas
• work on the positive
• discuss the benefits
• discuss the process of hypnosis
• get feedback for the client
Other additional extras for example may be giving the client some affirmations that they practice, asking the client to keep a food or thought diary but be prepared for any unresolved emotions to come out.
Most people with weight issues will identify a cause from the following (handout and Hadley and Staudacher p 60>):
• Eating to lessen an unpleasant experience – in growing up we are rewarded with a treat if we hurt ourselves, in pain and being ‘brave’.
• Eating to get attention and gain authority – large people get attention, may not be welcome attention. Size makes people feel more important.
• Eating for reward and entertainment – in growing up we are rewarded with treats for being good, for clearing the plate.
• Food for fear – to help them deal with fear
• Food replaces love - food is a safe partner
Hadley and Staudacher (p65) provide some actions and plans to assist the client make a lifetime plan for change. They argue that in analysing the When, Where, and Why the client eats the therapist can devise a plan with the client to avoid these triggers and provide new options. Once this is detailed and options established they argue that the overall objective are the same for all clients.
• To experience weight loss
• To maintain weight loss
• To incorporate new habits into your life
The key objective is the latter objective for the client to reprogram the subconscious to incorporate new habits necessary for weight loss by:
• Giving less importance to food as it relates to your feeling of well being. “I eat the correct and reasonable amounts and I am totally satisfied”
• Build up your confidence and self esteem so you can expect a slimmer self. “I reflect on all the positive things in my life, the goals and successes I have already achieved”......” I look great and feel so good”
• Increase the appeal of healthier foods. Make them more desirable and make fatty foods less desirable. “and now imagine a table in front of you and I fill this table with foods that are harmful to me......so now I push the food off the table and replace with healthier food that I enjoy...”
• Incorporate into your life new patterns of behaviour in regard to times, places and reasons for overeating. “I now have new ways of dealing with my old habits” “when I am.....I will” and include options from the when, where and why.
In the case of Miss E from the information we have she:
• Has struggled with weight since she was 12 or 13. She says her parents badgered her about being unattractive and eating too much. She may have some deeper issues of critical parenting or loving parenting gone ‘wrong’. They may have been trying to stop her eating too much by saying she would be unattractive however Miss E sub conscious may have created feelings of guilt and conflict and perhaps has internalised the message in as she is unattractive.
• Wants to achieve a weight loss of 2.5 stone. Indications are that she wants to achieve this weight loss in 3 months for an all girl holiday although this is not clear if the case. The therapist will need to be realistic and objective if this is ‘safe’.
• Her 6 year Relationship ended 6 months ago and it appears her partner was controlling and encouraged her to stay overweight. There may be deeper issues with regards to her previous partner, it is evident that the relationship was based on an uneven scale with her partner being ‘very controlling’ and ‘seeming to want her to stay overweight’. It could be that the unsupportive attitude of Miss E’s ex partner towards her effort to lose weight may be down to his own insecurities, believing that the change in her appearance could lead to people finding her more attractive and potentially, have her stray away from the relationship.
• Has tried diets in the past and although they worked for a while she always put weight back on. Miss E’s partner has been reluctant for her to lose any weight, changes to her eating plans were probably overlooked or ridiculed by her partner so in her subconscious diets would be held as something negative for her as he didn’t approve. The message was that they were a waste of time or something not to bother with. Miss E may not have had the willpower to carry on with the diet.
The therapist should discuss with the client if the target weight loss can be achieved in the time desired by her, examining if it is actually realistic and healthy for her.
The therapist must also be mindful if the client actually needs to lose weight or ending up supporting someone to remain at an unhealthy weight. Assuming Miss E is actually overweight then the ideal aim is to lose weight about 1 to 2 lbs per week (handout 6) and at this rate it could take between 17 – 35 weeks and not 12 weeks. This would have to be explained to Miss E to encourage realistic expectations towards the effects of hypnotherapy. The therapist must also explain that in order to lose weight then Miss E must consume fewer calories and begin to exercise; eat less, move more. This will avoid potential feelings of disappointment or failure when the weight loss is not achieved for the target
time.
Possible treatment
I believe that following information from the notation and initial interview would allow the therapist to identify the personality type of the client in order to write a screed personalised towards them and their preferred modality. I would be recommending at least 3 sessions to the client and review after each session.
The plan for Miss E would reflect a structured and realistic idea regarding weight loss. She also has received lots of negative comments from her parents and partner yet has had no positive supportive messages from them. Body image is very important in our society today and Miss E may be caught up in this.
I would want to address some of this through using a self esteem and motivation screed.
Self esteem is a prominent aspect with for Miss E in regards to her parents and her boyfriend. Although our self esteem should come from within, it is noted how we are also influenced by many other external factors. However, if we are made to feel fat and ugly as a child by our parents, we accept this as being our identity, turning our own inner confidence elusive and taking on board the ideals of someone else. This is reinforced by messages from our environment, media and society that we are ‘fat’ and ‘ugly’ or ‘imperfect’.
All of these points indicate a deep lack of self-esteem for Miss E and Hadley and Staudacher discuss improving self esteem and motivation (p151>) argue that “Self-esteem is one of the fundamental influences on nearly everything you do. When your self-esteem is low, almost all areas of your life working, socialising, loving are made more difficult” (p152).
Hadley and Staudacher advise that to improve self-esteem and deal with that critical inner voice not just for today but permanently is by reprogramming the subconscious. They specifically advocate including in the
induction:
• Getting rid of past negative programming
• Improve self projection
• Increase confidence and self acceptance
• Change your perspective on your relationship to a given problem I would also want to discuss with Miss E if one of the group of girls going on holiday with her would be a buddy for her, someone who could keep her positive. (Miss E may be a member of weight watchers or similar and may have a buddy there).
Another suggestion would be to use the why, when and where table to identify the situation and prepare other options. I would also combine this with a food diary and or a success journal together with the visual benefits of weight loss star chart would help keep Miss E motivated. This will not only enable her (but also the therapist) to see any correlations that may emerge (whether it is at certain times of the day or related to specific places/circumstance) so these can be examined and suggestions on how those particular situations can be dealt with and discussed.
The therapist should bear in mind that once Miss E’s self esteem has been addressed then there is a possibility that she may accept herself for what she is. The therapist should deal with this sensitively according to how overweight or not the client is and what the condition is of the health of the client.
After reviewing session 1 I would then use session 2 for the main weight loss screed (see attached). I would possibly add in some reinforcement of the self esteem. I would also prepare recordings of the screeds and some affirmations for the client to use daily. There are some current arguments on using hypnotherapy to get the client to believe that they have a gastric band fitted however I do not feel comfortable doing this at present.
Using the tools available I would have established the aforementioned when, where and why; the amount she ate; the way in which she used food; and identify the habit that has been established in her subconscious. In order to change her negative eating habits, a new habit must be created. This will require her to reprogram her subconscious, which can be achieved through the use of hypnosis.
Conclusion
Using hypnotherapy in weight loss is that the subconscious is altered so that the person alters their lifestyle to a healthier one. They will make healthier choices, this becoming a habit for them instead of their previous more harmful habit (handout 6). I belive that in taking this approach discussed, and that if Miss E is a willing participant who is ready for change then hypnosis would be of benefit for her.

Bibliography
Chrysalis Course Handout Diploma in Psychotherapeutic Counselling Year One Hypnotherapy and Counselling Skills 2013 – module 6
Josie Hadley & Carol Staudacher (3rd Edition 1996) Hypnosis for Change
Hellmut W. A. Karle & Jennifer H. Boys. 2nd (edition 2010 ) Hypnotherapy A practical handbook